Growth Hormones

Prior Authorization Call Line: 1-877-309-9493

Prior authorization of Growth Hormones for enrollees 21 years of age or older has been implemented to address appropriate
utilization consistent with approved indications including factors associated with long-term efficacy, public health and potential
for overuse or misuse. Only the prescriber, not their authorized agent, can initiate requests for prior authorization of
Growth Hormones for enrollees 21 years of age or older.

The following is general information about Growth Hormones prior authorization requirements:

Prescribers, not their authorized agents, are required to call the clinical call center toll free number
1-877-309-9493 and respond to a series of questions that identify the prescriber, the patient and the reason for prescribing
a drug in this class for enrollees 21 years of age or older.

Five refills for Growth Hormone prescriptions are allowed.

If you are prescribing Growth Hormones for enrollees under the age of 21, please refer to the Preferred Drug Program
web page and review the list of preferred and non-preferred drugs.